摘要
[目的]探讨Fulcrum-bending(支点弯曲位)像对伴发Chiari畸形和(或)脊髓空洞的脊柱侧凸手术治疗的帮助及新思路,并分析手术疗效。[方法]18例伴发脊髓空洞和(或)Chiari畸形的脊柱侧凸患者的治疗方案分两组:(1)牵引后前后路联合脊柱侧凸矫形手术(6例):对脊柱侧凸有手术矫形指征、伴发无明显神经损害的Chiari畸形和(或)脊髓空洞者,先行Halo颅骨牵引,1周后行脊柱侧凸矫形手术;(2)直接行后路脊柱侧凸矫形手术(12例):术前拍Fulcrum-bending像,并根据其结果对脊柱侧凸进行矫形。[结果]6例牵引后手术患者Cobb’s角平均矫正率为61%;6例柔软型侧凸患者直接后路手术患者均未出现神经并发症,Cobb’s角平均矫正率为60%,且术前Fulcrum-bending像与术后Cobb’s角相接近;6例僵硬型侧凸患者中1例出现轻微神经损害情况,后逐渐恢复,Cobb’s角平均矫正率为52%,手术存在过度矫正。[结论]对无明显神经损害的伴发脊髓空洞或ChiariI型畸形的脊柱侧凸柔软患者,不必行术前牵引而直接行后路手术,且可以获得与牵引后前后路联合手术类似的矫形效果。
[Objective] To evaluate the value of Fulcrum-bending radiograph and new treatment strategy to the scoliosis with Chiari malformation and/or syringomyelia,and to analyze the effect of operation.[Methods]Eighteen cases suffering from scoliosis with Chiari malformation and/or syringomyelia were divided into 2 groups for surgical treatment.(1)Group 1:six cases had scoliosis with Chiari malformation and/or syringomyelia without obvious neurological impairment.Their scoliosis was corrected with anteroposterior instrumentation afer one week of Halo's traction.(2)Group 2:another 12 patients having similar scoliosis underwent posterior orthopedic operation according to the result of preoperative suboccipital Fulcrum-bending radiograph.[Results]In 6 patients who underwent opration after traction,the average frontal correction rate was 61%.In another 6 cases having soft scoliosis with only posterior operation,the average frontal correction rate was 60%,and the result of opration came close to the Fulcrum-bending radiograph's.But in 6 cases having rigid scoliosis with only posterior operation,the average frontal correction rate was 52%.One patient had nervous lesion and gradually recovered.There existed excessive rectification.[Conclusion]Patients with soft scoliosis with Chiari malformation and/or syringomyelia without obvious neurological impairment can be operated on according to Fulcrum-bending radiograph without preoperative traction,and the therapeutic effect is similar to classic operative result.
出处
《中国矫形外科杂志》
CAS
CSCD
北大核心
2010年第5期373-376,共4页
Orthopedic Journal of China